October 31, 2016 - Dr. David Chao
Monday Morning MD: Time for transparency
Transparency is long overdue. Why not let the doctors speak or provide rationale for return to play decisions? Once again we have another concussion controversy involving a quarterback. Last season we had Case Keenum. In the NFL opener, Cam Newton became the national focus. Now we have the Alex Smith situation. The Chiefs QB’s head hit the turf, lacerating his ear, and had to be helped up by Spencer Ware (who ironically later suffered his own concussion) and a referee. Smith passed a concussion test and was returned to the game. The QB later suffered a second blow to the head on the turf and was then deemed to have a concussion. I am not suggesting that the Chiefs or any doctor did anything wrong here. I am saying the optics of the situation are not good when a wobbly QB is allowed to stay in the game. The latest concussion controversy deserves explanation. Credit head coach Andy Reid for trying to address it post game (even though he erroneously said Smith passed both concussion tests). However, when pressed, coaches always use the “I am not a doctor” line and say I just followed the doctor recommendations. Why not let the medical staff speak or at least release a statement? Of course the player would have to grant permission, but perhaps that would clear up the misperceptions. Maybe the physician, knowing he would have to publicly defend his decision, causes a further pause before a player is cleared. I don’t believe in conspiracy theories. Certainly the unaffiliated neurotrauma consultant (UNC) who lives in Indianapolis was not incentivized to keep Smith in the game to help the Chiefs beat his hometown Colts. I believe the doctors are doing their best with an inexact science of diagnosing concussions. I have been there and know what a difficult job it is. It is impossible to get every "play/no play" decision correct, like it is impossible to expect a referee to get every call right. My point is why not let the public know about the process and what the doctor’s thinking was? Even the referee has to answer a pool reporter’s questions post game. I am curious as to what the referees were thinking on this first hit. The umpire was one of two people there to help hold Smith up and referees are also charged with player health. I would also love to hear the UNC’s side of the story. Did the UNC see a wobbly Smith? Was he provided with the video replays? What lead him to clear the player? Even if a player passes concussion tests, visual evidence of a balance issue is enough to rule a player out. The NFL has been accused of conspiracy and denial in the concussion crisis. Why not shed that image and allow some transparency in the current head injury decisions? Not allowing for comment just makes the situation look worse. MMMD 1: Good injury week Overall Week 8 seemed to be the least injuries for 2016, yet there were still plenty. The year to date has seen a slightly higher rate than average with 40 ACL tears and 32 Achilles ruptures. Lets hope we don’t get Monday morning bad news. Or as seems to be the pattern this year, Wednesday bad news like we did for Adrian Peterson, Dez Bryant, C.J. Anderson and others. MMMD 2: Two stars trying to return Ben Roethlisberger and Terrell Suggs are both coming off injury and a bye week to face off in a big divisional game. Big Ben will be three weeks after a knee scope. Suggs suffered a biceps tendon tear. There are varying reports of stitches and whether Roethlisberger will be ready. Medically, expect him to play. The sutures are in the skin, not the meniscus; therefore, will be removed and is a non-issue. Suggs is forgoing surgical repair to play through what may be his final season in the NFL. MMMD 3: All meniscus tears not the same Earlier this season we covered the difference between the Adrian Peterson and Big Ben meniscus tears. Now we have additional examples. C.J. Anderson had his meniscus repaired, which means six weeks of rest and minimum three months of recovery. Michael Bennett’s return timeline after his cartilage trim procedure is set at 2-3 weeks. Trimming meniscus is like mowing the lawn where you can play football immediately after, while repairing is like laying down new sod where you need to keep of the grass to let the roots grow in. MMMD 4: Time to worry for Jamaal Charles Swelling when increasing activity after an ACL surgery is not unusual. When it does not go away for several weeks, the effusion becomes a concern. Charles is now seeking a second opinion. Hopefully, rest, time, compression, medication and draining the knee will be enough. I hope there is no need for a post-ACL knee scope. MMMD 5: Worst injury of the season Texans right tackle Derek Newton ruptured both of his patella tendons last Monday. Even though there was a report of successful surgery to repair both tendons, he has a long path to return to the NFL. Three players have torn both patella tendons at the same time: Wendell Davis, Gary Baxter and Greg Childs. None of the three returned to their pre-injury levels of play. Hopefully, Newton can be the first. The road game presented several difficulties. First, Newton did not have access to pain medicine immediately as the visiting team is not allowed to bring narcotic medication per federal laws and the home team medication supply is limited. Second, the 300+ pound lineman was essentially wheelchair bound and could not fly home with the team but instead needed special medical transport. MMMD 6: Injury rundown Broncos defensive coordinator Wade Phillips was knocked over on the sidelines and rushed to the hospital. Fortunately rumors of a broken leg were inaccurate and he passed all tests and was released. Four players were concussed during the Chiefs at Colts game: Alex Smith, Spencer Ware, Joe Reitz and Vontae Davis. Statistically expect at least two of the four to miss next week’s game. Jacquizz Rodgers injured his left foot but video was not clear as he was in a pile and the mechanism or severity could not be seen. Ty Montgomery has a kidney-related ailment. It is unclear what type or how long he might miss. Martellus Bennett continues to deal with a high ankle sprain. He injured it in Week 5 and still caught three touchdown catches. Here is hoping the bye week gives him a chance to fully heal. Barry Church fractured his right forearm, the same side that he broke causing him to miss the last game of 2015. He likely will undergo plating surgery and return in 4-6 weeks. Morris Claiborne has a significant groin injury. Sometimes one can play through or the Cowboys could make the decision to fix it now to be back by the end of season/playoffs. By video, Charles Clay suffered a left shoulder AC joint sprain but returned to the game. Sean Smith appeared to subluxation/dislocate his left shoulder. If he torn his labrum, that could mean surgery or trying to play with a brace as Charles Woodson did last year for the Raiders. Duke Ihenacho suffered a scary hit in London. After a substantial time on the ground, was able to walk off under his own power. Vontaze Burfict's knee injury does not appear to be serious. By video, he suffered a contusion to the muscles in back of his left knee and he did return to the game. Meanwhile, Burfict inadvertently hit Rey Maualuga’s left arm but there was no fracture and he ultimately continued as well. Russell Wilson was able to play through his pec, knee and ankle injury but not well enough to come away with victory. Tyran Mathieu left the game with an unspecified shoulder injury. Hopefully the follow up news will be good. Sammy Watkins is out of his boot. That certainly is a good sign but only a first step to return and there is no medical certainty that he can come off IR when eligible in a month. MMMD 7: ProFootballDoc scorecard By video, I did not expect Geno Smith to tear his ACL. Demarcus Ware did return after ulna plating surgery and even had a strip sack fumble with his right arm that was reversed. Lamar Miller played with what has been confirmed as a deltoid contusion. Antonio Brown’s hip contusion is confirmed to be progressing well for this Sunday and will not miss time. Duke Ihenacho, Vontaze Burfict and Rey Maualuga injuries are all less significant than originally feared. Derek Newton was confirmed with bilateral patella tendon ruptures. Counting the missed ACL tear lowers the previous 89-4 (94.7%) record to 96-5 (95.0%). Happy Halloween to everyone!